The first 50 websites identified on searching the Internet for 'weight loss diets' were assessed systematically and their content compared with published clinical guidelines for management of obesity. The relevance and quality of the sites varied enormously. Only 3 confined themselves to sound dietary advice. Most promoted dietary supplements or other 'slimming aids', often of uncertain composition and based on dubious physiological principles. Potential hazards--for example, those of very low calorie diets--were rarely highlighted and certain regimens on offer were potentially dangerous. (+info)
Direct multiplex amplification of DNA from a formalin fixed, paraffin wax embedded tissue section.
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The extraction of DNA from formalin fixed, paraffin wax embedded tissue can be problematical, with long protocols producing low yields. This report describes a very simple and useful method for amplifying DNA from formalin fixed, paraffin wax embedded tissue without the need for prior DNA extraction. This method allows direct polymerase chain reaction (PCR) based molecular analysis of fixed tissue. It is an invaluable method if clinical biopsy specimens are to be investigated, because extraction of uncontaminated DNA from such small samples can be very difficult or even impossible. It will also facilitate the study of intratumour heterogeneity, with the analysis of multiple small areas from within a single tumour section. In addition, this method can be used for other samples where only a few tests are to be carried out and a stock of DNA is not required, thus shortening the analysis time. (+info)
ACP Best practice no 159. Examination of large intestine resection specimens.
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Macroscopic examination of large intestinal resection specimens by the surgical pathologist provides important diagnostic and prognostic information. This review summarises current recommended protocols and evidence based guidelines for gross description, dissection, and histological block selection in both neoplastic and non-neoplastic colorectal disease. Specific lesions discussed include colorectal cancer, polypectomies and polyposis syndromes, and inflammatory bowel disease. Microscopic examination is briefly described, with emphasis on certain pitfalls that might be encountered in routine practice. A section covering special techniques for the investigation of occult bleeding is included. (+info)
Sources of influence on medical practice.
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OBJECTIVES: To explore the opinion of general practitioners on the importance and legitimacy of sources of influence on medical practice. METHODS: General practitioners (n=723) assigned to Primary Care Teams (PCTs) in two Spanish regions were randomly selected to participate in this study. A self administered questionnaire was sent by mail and collected by hand. The dependent variable collected the opinion on different sources that exert influence on medical practice. Importance was measured with a 9 item scale while legitimacy was evaluated with 16 items measured with a 1 to 7 point Likert scale. RESULTS: The most important and legitimate sources of influence according to general practitioners were: training courses and scientific articles, designing self developed protocols and discussing with colleagues. The worst evaluated were: financial incentives and the role played by the pharmaceutical industry. CONCLUSIONS: The development of medical practice is determined by many factors, grouped around three big areas: organisational setting, professional system and social setting. The medical professional system is the one considered as being the most important and legitimate by general practitioners. Other strategies of influence, considered to be very important by the predominant management culture (financial incentives), are not considered to be so by general practitioners. These results, however, are not completely reliable as regards the real network of influences existing in medical practice, which reflect instead different "value systems". (+info)
Failure of thrombolysis: experience with a policy of early angiography and rescue angioplasty for electrocardiographic evidence of failed thrombolysis.
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OBJECTIVE: To assess the outcome of a policy of emergency coronary angiography with or without rescue angioplasty in patients with acute myocardial infarction and ECG evidence of failed reperfusion after thrombolysis. DESIGN: A cohort study. SETTING: Regional cardiothoracic unit. PATIENTS: 197 patients with acute myocardial infarction fulfilling a simple ECG criterion of failed reperfusion. INTERVENTIONS: Emergency coronary angiography proceeding to rescue angioplasty for inadequate antegrade flow. MAIN OUTCOME MEASURES: Hospital mortality for all 197 patients; incidence of successful and failed rescue angioplasty; need for additional revascularisation in those receiving rescue angioplasty compared with those not treated in this way. RESULTS: 197 patients had emergency angiography for ECG evidence of failed reperfusion; 156 patients received immediate rescue angioplasty. Overall hospital mortality for those undergoing rescue angioplasty was 11.5%. Rescue angioplasty achieved TIMI 2 (11) or TIMI 3 (124) in 135 patients, who had a hospital mortality of 5.9%. Failure to achieve at least TIMI 2 flow following rescue angioplasty occurred in 21 patients, with a hospital mortality of 48%. In the 41 patients in whom immediate rescue angioplasty was not performed, reinfarction or requirement for revascularisation occurred in 37%. Reinfarction occurred in three patients (1.9%) who had immediate rescue angioplasty. Hospital mortality for the whole cohort was 10.7%. CONCLUSIONS: A policy of emergency coronary angiography proceeding to rescue angioplasty where appropriate reduces mortality in a high risk group to a level less than expected for patients with acute myocardial infarction and ECG evidence of failed reperfusion. Unsuccessful rescue angioplasty is associated with a high mortality. (+info)
Management of patients with community-acquired pneumonia in a primary care hospital: a critical evaluation.
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The aim of the study was to evaluate routine management of patients with community-acquired pneumonia (CAP) with regard to severity patterns, diagnostic approaches and results, as well as initial empiric antimicrobial treatment and its impact on outcome. Two hundred and thirty-two consecutive patients with CAP admitted to a primary care hospital were studied prospectively. Patients were classified according to Fine's severity score. Severe pneumonia was defined as admission at the ICU. Diagnostic approaches and initial antimicrobial treatment were judged according to the guidelines of the European Respiratory Society (ERS). Fifty-five patients (24%) had mild, 156 (67%) moderate, and 21 (9%) severe CAP. At least one microbial examination was performed in 124 patients (54%). There was no association between microbial investigation and severity of CAP. Inadequate initial antimicrobial treatment was significantly more frequent in severe (18/21, 86%), than in mild (5/55, 9%) and moderate CAP (39/156, 25%, P < 0.0001). Conversely, antimicrobial overtreatment occurred significantly more often in mild (30/55, 55%) and moderate (77/156, 49%) than in severe CAP (0/21, 0%, P < 0.0001). Inadequate initial antimicrobial treatment was more frequent in non-responders [18/62 (29%) vs. 31/170, (18%), RR 1.6 95% CI 0.9-2.6, P = 0.07] and was associated with a longer duration of hospitalization (17 +/- 11 vs. 14 +/- 8 days, P = 0.03). Mortality was not affected by inadequate initial antimicrobial treatment [5/62 (8%) vs. 10/170 (6%), RR 1.4 95% CI 0.5-3.9, P=0.55]. Principal conceptual weaknesses which might be subject to intervention were (1) the hospitalization of patients with mild pneumonia at low risk of mortality; (2) the lack of association between microbial investigation and severity of CAP; (3) antimicrobial overtreatment of patients with non-severe CAP; and (4) inadequate antimicrobial treatment with increased number of primary treatment failures and duration of hospitalization. (+info)
Measuring lung function in infancy.
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Although the earliest reliable lung function tests in infants were performed as long as 40 years ago, there has only recently been a growth in this area, as simpler methods and better equipment and IT resources have been developed. Exciting information is accumulating about the normal physiology and pathology of the infant lung. Many basic questions are still unanswered and the ability to perform these tests remains confined to a few specialized centres. To co-ordinate the development of ILFT and establish standardization in a number of areas including measurement conditions, equipment specifications, methodology protocols and data analysis, international collaboration is necessary between the teams working in this field (Table 5). Collaborative groups are currently addressing these issues and are also developing recommendations regarding the design of randomized clinical trials, multi-centre studies and research agendas. Infant lung function testing remains primarily a research tool. Our aim should be not only to refine and develop the techniques of physiological measurement but to apply ILFT to the objective study of respiratory illness in infants in the clinical setting so as to aid in the prevention and treatment of these common, debilitating and costly diseases. (+info)
Visual pigment reconstitution in intact goldfish retina using synthetic retinaldehyde isomers.
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A protocol has been developed for reconstituting visual pigments in intact retinae by delivering synthetic isomers of retinal incorporated in phospholipid vesicles. Calibration curves have been constructed relating the lambda(max) of the native porphyropsins (visual pigments based on 11-cis 3-dehydroretinal) of the rods and four spectral classes of cone in the goldfish, and the equivalent photosensitive pigments regenerated from 11-cis retinal (rhodopsins) and the commercially available isomer, 9-cis retinal (isorhodopsins). The relationship between the lambda(max) of rhodopsins and isorhodopsins appears to be linear, such that the difference in lambda(max) changes sign at about 380 nm. We therefore conclude that the protocol for reconstituting visual pigments with 9-cis retinal is suitable for all classes of vertebrate opsin-based photopigments. (+info)